Comment
The Lancet at 200 years: a timeless mission to drive positive
For the special issue on
advancing racial and ethnic
equity in science, medicine,
and health see Lancet
2022; 400: 2007–154
1200
social change through advancing medical research and science
The Lancet was founded in 1823 by Thomas Wakley with
the vision to drive positive social change by advancing
medical research and science for the greater good, by
addressing inequities of the time with access to medical
knowledge for “medical and surgical practitioners” in
the UK and the British colonies (as they were referred to
at the time), and by being more than a medical journal.
The Lancet has remained true to its core mission to drive
positive social change, which is as relevant today as it was
groundbreaking then, through the past two centuries
amid seismic changes in our world.
During the past 200 years, average life expectancy has
more than doubled globally,1 partly thanks to better
health care, hygiene, and nutrition—all of which are
underpinned by scientific, technological, and economic
progress. 200 years ago, about 40% of children
worldwide perished before the age of 5 years; today, the
under-5 child mortality rate is below 4%.2 Many diseases
that were previously fatal are now curable or manageable
conditions thanks to antibiotics, vaccines, targeted
medicines, immuno­ therapies, and surgical advances,
among others. The timeline shows some of the seminal
moments behind these devel­op­ments in the pages of
The Lancet over the decades (figure).
The Lancet has remained steadfast in its belief that
health and social progress go hand in hand, putting
inclusion, equity, and collaboration at the heart of
scientific enquiry and policy change. The journal has
done this boldly, not shying away from uncomfortable
debate, while evolving to become the world’s number
one medical journal with an unparalleled impact in
both academic and public spheres. The Lancet has
grown from a single journal with a hand printed run of
a few thousand copies3 for a privileged group in the UK
to become a family of titles read by tens of millions of
people around the world.
The centenary issue of The Lancet4 only featured pictures
of male doctors, many of them also acting as editors.
Now, half of The Lancet’s international editorial advisory
board are women. The Lancet has also put a spotlight on
racism as a global public health emergency and published
a special issue aimed at charting a path for advancing
racial and ethnic equity in science, medicine, and health.5
Equally important is The Lancet’s role in strengthening
trust in science, including during public health
emergencies. The Lancet team worked around the
clock with researchers from across the globe during the
COVID-19 pandemic, helping scientists understand and
find cures for the SARS-CoV-2 virus, starting with the first
research papers6,7 that came out of China in January, 2020.
In an increasingly polarised world, The Lancet’s
belief in partnership continues to build bridges across
borders, with science and medicine as the unifying
bonds. The Lancet’s many Commissions are strong
vehicles for scientific review and enquiry into urgent and
understudied health predicaments that affect people
everywhere. They are multidisciplinary, global, and
focused on transformative change. The Commissions
are not led by The Lancet, or Elsevier as its publisher, but
by science.
We are at the precipice of another pivotal moment
for the world, tested by several grand challenges. As
the Lancet Countdown on climate change calls out, this
existential crisis is a global health issue.8 Meanwhile,
populations worldwide are living longer and want access
to quality health care, which comes with increased
costs to systems and added pressure on doctors and
nurses, many of whom are leaving their profession.
Geopolitical tensions are at their highest since the end of
the Cold War, challenging the spirit of global cooperation
in science and health care. Long embedded inequities
in society are resulting in poor health outcomes for the
most vulnerable. All these challenges require deep and
profound focus and collaboration across health-care
communities, governments, and society.
I remain confident that the future will bring even
more openness, transparency, interdisciplinary research,
reproducibility, and more equitable and inclusive
participation in the scientific endeavour. Responsible
use of artificial intelligence and large language machine
learning technologies, immense datasets, open channels
of sharing knowledge, and greater public interest in the
scientific process all present exciting opportunities. As
we look to the next 200 years, there is no doubt in my
mind that The Lancet will continue to have a pivotal role
in scientific enquiry and medical advancement, and that
www.thelancet.com Vol 402 October 7, 2023
 Comment

The Lancet, Elsevier Ltd

Figure: Timeline of some of the key events in 200 years of The Lancet

it will continue to boldly catalyse social and policy change I am the Chief Executive Officer of Elsevier, the publisher of The Lancet.
that benefits people and our planet. The progress made Kumsal Bayazit
over the past two centuries gives me deep confidence in k.bayazit@elsevier.com
the positive progress to come. I thank Thomas Wakley, Elsevier, London, UK
Richard Horton, and all the editors, authors, peer reviewers, 1 expectancy
Our World in Data. Life expectancy. 2019. https://ourworldindata.org/life-
(accessed July 12, 2023).
and publishing teams past, present, and future for staying 2 Our World in Data. Child and infant mortality. 2019. https://ourworldindata.
org/child-mortality (accessed Sept 19, 2023).
true to The Lancet’s core mission.

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 Comment
Stipple engraving by H. Fernell, 1835, after J K Meadows/
Wellcome Collection
For the Lancet Series see https://
www.thelancet.com/lancet/
series
For the Lancet Commissions see
https://www.thelancet.com/
lancet/commissions
1202
3 Sprigge SS. The life and times of Thomas Wakley, founder and first editor of
the “Lancet”. London: Longmans, Green and Company, 1897.
4 The Lancet. The centenary of The Lancet: October 5, 1823–October 5, 1923.
Lancet 1923; 2 (suppl): 686–764.
5 The Lancet. Advancing racial and ethnic equity in health. Lancet 2022;
400: 2007.
6 Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019
novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506.
The Lancet’s enduring legacy: speaking truth to power
When Thomas Wakley founded The Lancet 200 years ago,
the publication was labelled as “aggressive, offensive and
radical” in science.1 Speaking up against “incompetence,
privilege, and nepotism” the journal inevitably caused
controversy. Since then, while The Lancet has grown to
be among the most celebrated and revered sources of
scientific knowledge, it has stayed true to its roots with a
commitment to equity and accountability.
For example, in 2010, Pakistan had landed in
a complex, health-sector, institutional crisis as a
misinterpreted con­ sequence of a constitutional
amendment. As a result, the Ministry of Health
was abolished and dismantling of federal level drug
regulation resulted in 230 deaths due to contaminated
prescription drugs. It was The Lancet that fast-tracked
publication of two Comments2,3 (written by one of us
[SN]), boldly supporting a call for reinstatement of
these institutional arrangements at a time when it was
unthinkable to challenge a constitutional amendment.
In the same spirit, the journal has given voice to a
variety of settings and needs, irrespective of concerns
that powerful constituencies may be alienated.
The Lancet’s independence has been one of its unique
features. It has embraced the inherently political nature
of medicine and public health and has used its editorial
voice to speak truth to power consistently. For instance,
the Lancet COVID-19 Commission4 rightly called out
governments and international institutions for failing
to “adhere to basic norms of institutional rationality
and transparency”, for being slow to act, and for causing
vaccine inequity—findings which were deemed “harsh”
yet necessary.5 The Lancet had a central role in research,
policy, innovation, and publication during the COVID-19
pandemic, being the first journal to report the outbreak
in Wuhan, China, in January, 2020. Its publications
catalysed vaccine development and delivery and
informed public health policies.6,7
7 Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of
global health concern. Lancet 2020; 395: 470–73.
8 Romanello M, Di Napoli C, Drummond P, et al. The 2022 report of the Lancet
Countdown on health and climate change: health at the mercy of fossil fuels.
Lancet 2022; 400: 1619–54.
The journal is known best for using evidence as a
tool for accountability; this tenet was realised most
successfully in the reports of the Lancet Countdown on
health and climate change,8 which revealed that the
policies and actions of governments and companies
threaten the health and survival of humanity.
Despite being a general medical journal, The Lancet
has committed itself to global conversations about
medicine and public health, providing a platform for
health workers and scientists worldwide; it is known
as the voice of social justice, for bringing attention to
crucial topics affecting marginalised populations, and for
spotlighting neglected areas.
Lancet Research and Review papers highlighted the
work of the Countdown to 2015 for Maternal Newborn
and Child Survival, helping to track progress and drive
accountability for women’s and children’s health.9,10
Similarly, Lancet Series on non-communicable diseases
(NCDs) and the Lancet NCD Countdown Health Policy
papers11 have helped to draw attention to one of the widest
gaps in public health between knowledge regarding the
magnitude of the problem and the corresponding policy
response in public health, and provided an independent
mechanism for countries to monitor their progress to
the Sustainable Development Goal target of one third
reduction in premature mortality from NCDs by 2030.
The Lancet has also shed light on neglected tropical
diseases, which largely affect poor populations in low-
income and middle-income countries.12 The Lancet’s Series
and Commissions have also galvanised political action for
maternal, newborn, child, and adolescent health when the
world had deprioritised it and a considerable proportion of
funding had instead been directed to other causes, such as
HIV, tuberculosis, and malaria.
The Lancet’s programme of Series (since 2003) and
Commissions (since 2009) uses knowledge as an
instrument to accelerate social and political change and
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